癫癎儿童发作间期癫癎样放电特点初步研究

Interictal epileptiform discharges in children with epilepsy

摘要:

目的：癫癎发作及癫癎样放电具有昼夜倾向，睡眠是诱发癫癎的重要因素之一，但睡眠触发癫癎的易感性在不同的睡眠时相对发作及发作间期癫癎样放电的影响并不相同。该文主要研究局灶性及全面性癫癎儿童发作间期睡眠和觉醒状态癫癎样放电的特点。方法：采用24 h动态脑电图、多导睡眠脑电图及长程视频脑电图仪描记48例原发性癫癎儿童的全夜睡眠（至少一个完整的睡眠周期）和睡眠前后觉醒状态的脑电资料，统计分析觉醒期及各睡眠期棘/尖波、棘/尖慢波等癫癎样波的放电指数的差异，比较局灶性和全面性发作类型癫癎儿童癫癎样放电阳性率的差异。结果：局灶性癫癎儿童组发作间期脑电图癫癎样放电的阳性率高于全面性癫癎儿童组（16/25，64.0%）vs（9/25，36.0%），（P<0.05）。癫癎患儿非快速动眼睡眠各期（S1~S4）癫癎样波放电指数为21.13±19.96，19.59±17.76，22.85±18.99，20.37±16.63，均高于觉醒期的8.20±6.21（P<0.05）。非快速动眼睡眠期S3期癫癎样波放电指数明显高于快速动眼睡眠期（22.85±18.99 vs 12.91±10.95），（P<0.05）。结论：局灶性癫癎儿童发作间期脑电图癫癎样放电的阳性率较全面性癫癎儿童癫癎样放电阳性率高。睡眠，尤其是非快速动眼睡眠期对癫癎儿童癫癎样放电具有易化作用。

Abstract:

OBJECTIVE: To study the features of interictal epileptiform discharges (IED) during sleep and wakefulness in children with epilepsy.METHODS: The polysomnography, active EEG and video EEG were performed on 48 children with epilepsy during the whole night, and wakefulness of pre- and post-sleep. The epileptiform sharp/spike discharge indexes during sleep and wakefulness were recorded. The positive rate of IED in focal and generalized epilepsy was compared.RESULTS: Of the 48 patients, 25 showed IED, including 9 cases (36.0%) in the generalized seizure group and 16 cases（64.0%） in the focal seizure group（P<0.05）. The epileptiform sharp/spike discharge indexes in the whole non-rapid eye movement (NREM) sleep stage (stages S1-S4: 21.13±19.96, 19.59±17.76, 22.85±18.99, and 20.37±16.63) were significantly higher than that in the wakefulness stage (8.20±6.21) (P<0.05). The discharge index in the S3 stage during NREM sleep was higher than that during the rapid eye movement (REM) sleep (22.85±18.99 vs 12.91±10.95; P<0.05).CONCLUSIONS: The positive rate of IED in the focal seizure group was higher than that in the generalized seizure group. Sleep, especially NREM sleep, facilitates IED in children with epilepsy.